Outcomes of older adults aged 90 and over with cutaneous malignancies after electrochemotherapy with bleomycin: A matched cohort analysis from the InspECT registry. Issue 4 (April 2021)

• Record Type: Journal Article
• Authors: Sersa, Gregor; Mascherini, Matteo; Di Prata, Claudia; Odili, Joy; de Terlizzi, Francesca; McKenzie, Gordon A.G.; Clover, A. James P.; Bertino, Giulia; Spina, Romina; Groselj, Ales; Cappellesso, Rocco; Gehl, Julie; Bisase, Brian; Curatolo, Pietro; Kis, Erika; Lico, Valbona; Muir, Tobian; Orlando, Antonio; Quaglino, Pietro; Matteucci, Paolo; Valpione, Sara; Campana, Luca G.
• Is Part Of: European journal of surgical oncology. Volume 47:Issue 4(2021)
• Page Start: 902
• Page End: 912
• Publication Date: 2021-04
• Subjects: Oldest-old adults with cancer -- Bleomycin -- Electrochemotherapy -- Skin cancer -- Skin-directed therapies -- Wound healing; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.10.037
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Background: With extending life expectancy, more people are diagnosed with cutaneous malignancies at advanced ages and are offered nonsurgical treatment. We assessed outcomes of the oldest-old adults after electrochemotherapy (ECT). Methods: The International Network for Sharing Practices of ECT (InspECT) registry was queried for adults aged ≥90 years (ys) with skin cancers/cutaneous metastases of any histotype who underwent bleomycin-ECT (2006–2019). These were subanalysed with patients aged <90 ys after matching 1:2 for tumor location, number, size, histotype, and previous treatments. We assessed ECT modalities, toxicity (CTCAE), response (RECIST), and patient perception (EQ-5D). Results: Sixty-one patients represented the study cohort (median 92 ys, range 92–104), 122 the control group (median 77 ys, range 23–89). Among the oldest-old, 44 patients (72%) had primary/recurrent skin cancers, 17 (28%) cutaneous metastases. Median tumour size was 15 mm (range, 5–450). The oldest-old adults underwent ECT mainly under local/regional anaesthesia (59% vs 39% p = .012). We observed no differences regarding dose and route of chemotherapy (intravenous vs intratumoral, p = .308), electrode geometry (linear vs hexagonal, p = .172) and procedural duration (18 vs 21 min, p = .378). Complete response (57.4 [95%-CI 44.1%–70.0%] vs 64.7% [95%-CI 55.6%–73.2%], p = .222) and 1-year local control (76.7% vs 81.7, p = .092) rates were comparable. Pain and skin hyperpigmentation were mild in both groups. Skin ulceration persisted longer in the oldest-old patients (4.4 vs 2.4 months, p = .008). Conclusions: The oldest-old adults with cutaneous malignancies undergo ECT most commonly under local/regional anaesthesia with safety profiles and clinical effectiveness similar to their younger counterparts, except in case of ulcerated tumors. Highlights: The oldest-old patients with skin malignancies benefit from nonsurgical treatment Electrochemotherapy is gaining applicability in treating skin tumours The procedure is carried out preferentially under local/regional anaesthesia Outcomes are comparable to younger patients, with improved skin conditions Tumours with pre-existing extensive ulceration do not benefit from treatment